lord brain 2010 commemorative booklet

Inaugural Lord Brain Memorial Lecture 2010Professor Andrew Lees, “Brainwashed by the Black Stuff”Commemorative Booklet

ContentsProgramme

Message from Professor Gavin Giovannoni, Professor ofNeurology, Barts and The London

Biography – Lord Brain

The Neurological tradition at the London Hospital

Biography – Professor Michael Swash, Emeritus Professor of Neurology, Barts and The London

Biography – Professor John Hardy, Professor of Neurogenetics, UCL

Biography – Professor Andrew Lees, Director of the Reta Lila Weston Institute of Neurological Studies, UCL and first recipient of the Lord Brain Memorial Medal

Lecture abstract – Brainwashed by the Black Stuff

Neuroscience at Barts and The London

Blizard Institute of Cell and Molecular Science

Walter Russell Brain1895 - 1966

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Commemorative Booklet 03

ProgrammePerrin Lecture TheatreThursday 24 June 2010, 5:30pm

• Welcome addressProfessor Gavin Giovannoni, Professor of Neurology, Barts and The London

• History of Neurology at The LondonProfessor Michael Swash, Emeritus Professor of Neurology, Barts and The London

• IntroductionProfessor John Hardy, Professor of Neurogenetics, UCL

• LectureProfessor Andrew Lees, Director of the Reta Lila Weston Institute of Neurological Studies, UCL and first recipient of the Lord Brain Memorial Medal

• Personal PerspectiveProfessor Michael Brain,Lord Brain's son and ex–Chief of Haematology at McMaster University, Canada

• MedalAward and Presentation

• Reception

02 Inaugural Lord Brain Memorial Lecture


Message from Professor Gavin Giovannoni

Dear Colleagues,

Welcome to the firstLord Brain MemorialLecture.

When I wasappointed to Bartsand The London inlate 2006, I wasastounded by thehistory of the RoyalLondon and St

Bartholomew’s Hospitals and their respectivemedical schools. As a newcomer, I couldn’tunderstand why we weren’t acknowledging andcelebrating the achievements of these two greatInstitutions in the field of Neurology. The LordBrain Memorial Lecture and Medal is therefore acelebration and an opportunity to remember andacknowledge Walter Russell Brain’s outstandingcontribution to Neurology at Barts and TheLondon.

The biennial Lord Brain Memorial Lecture andMedal honours a healthcare professional orscientist who has worked in the United Kingdomand has made a major scientific contribution tofield of Neuroscience. The task of selecting therecipient of the first award was not an easy one asseveral outstanding candidates were nominated.I hope you all agree that Professor Andrew Lees is a worthy recipient of the award. The fact thatProfessor Lees is an alumnus of this medicalschool makes the evening even more significant.I had the privilege of working for Professor Leesas his last Senior Registrar at Queen Square andUCLH during which time we described dopamine

dysregulation syndrome in Parkinson’s disease. It is a remarkable coincidence that JamesParkinson, who first described the disease, wasalso an alumnus of The Royal London, makingthe subject of Professor Lees’ talk tonight verypertinent.

I would like to welcome Lord Brain’s family whoare attending this evening, with a special ‘thankyou’ to Christopher and Nicola, Lord Brain’s sonand granddaughter, for being so accommodatingand supportive of this initiative.

Events of this nature do not just happen and Iwould therefore like to thank the School ofMedicine and Dentistry for their long-termcommitment to this event and their financialsupport, Denise Sheer, Charlie Cockerell andNicola Brain co-members of the Lord Brainselection committee for their time and efforts,Professors Michael Swash and John Hardy foragreeing to talk this evening, Morag Brothwell forresearching and then writing a mini-biography onLord Brain and Surinder Pal, our administrator,who made this event happen.

Thank you for attending the lecture; I am surethat you will enjoy the evening.

Yours sincerely

Gavin Giovannoni


Professor Gavin GiovannoniMBBCh, PhD, FCP (S.A., Neurol.), FRCP, FRCPath Blizard Institute of Cell and Molecular Science Barts and the London School of Medicine and Dentistry

Gavin Giovannoni was appointed to the Chair of Neurology, Blizard Institute of Cell and MolecularScience, Barts and The London School of Medicine and Dentistry, Queen Mary University ofLondon and the Department of Neurology, Barts and The London NHS Trust in November 2006. In September 2008 he took over as the Neuroscience and Trauma Centre Lead in the BlizardInstitute of Cell and Molecular Science. Gavin did his undergraduate medical training at theUniversity of the Witwatersrand, South Africa, where he graduated cum laude in 1987 winning theprizes for best graduate in medicine and surgery. He moved to the Institute of Neurology, UniversityCollege London, Queen Square, London in 1993 after completing his specialist training inneurology in South Africa. After three years as a clinical research fellow, under Professor EdThompson, and then two years as the Scarfe Lecturer, working for Professor W. Ian McDonald, hewas awarded a PhD in immunology from the University of London in 1998. He was appointed as aClinical Senior Lecturer, Royal Free and University College Medical School, in 1998 and movedback to Institute of Neurology, Queen Square in 1999. He was promoted to Reader inNeuroimmunology in 2004. His clinical interests are multiple sclerosis and other inflammatorydisorders of the central nervous system. He is particularly interested in clinical issues related tooptimising MS disease modifying therapies. Gavin’s current research is focused on Epstein Barrvirus as a possible cause of multiple sclerosis, defining the “multiple sclerosis endophenotype”,multiple sclerosis related neurodegeneration, multiple sclerosis biomarker discovery, multiplesclerosis clinical outcomes and immune tolerance strategies. Gavin's team focuses on translationalresearch and run an active trail programme.

programme.

unconscious, which inspired Brain to consider acareer in psychiatry. But Riddoch advised himthat he’d ‘better learn some neurology first.’ And so he did, but he never lost his interest inpsychiatry and the workings of the human mind.Some years later, Brain became interested in theconundrum of consciousness and themechanisms of perception. When neither hisneurological expertise nor philosophical theoriescould offer sufficient explanations, he soughtanswers in his own philosophical musings,displayed in his book Mind, Perception andScience (1951).

Once qualified, Brain’s ascent was rapid.Following his house physician years at theLondon, he moved to Maida Vale Hospital forNervous Diseases to work as a registrar and waslater appointed physician. He then returned tothe London Hospital in 1925 and was elected tothe staff in 1927. These were his mainappointments until retirement. With Eric Strauss,with whom he had been a medical student atNew College, he wrote and edited a series ofreviews Recent Advances in Neurology andNeuropsychiatry. This was first published in1929 and was hugely popular. It was followed in 1933 by his seminal work Diseases of theNervous System, which he continued to reviseuntil 1962. Clinical Neurology, a shorter text forstudents, was published in 1960, and hismonograph, Speech Disorders in 1961. He wasthe editor of the journal Brain from 1954 until hisdeath, and for some time he edited the QuarterlyJournal of Medicine. During this time, Brain hadproved himself to be an excellent clinician with avery popular Harley Street practice. His patientsencountered a quiet, serious man of few words

but great wisdom and compassion. His famedsilences may have at times brought unease, butto those who knew him they were signs of deepthought. His observations during his clinics led to a number of significant contributions toneurology. However, one particular contributionresulted from a problem he observed closer tohome. Brain had noticed how his wife wouldcomplain of pain and paraesthesia in her handafter pruning shrubs in the garden - a commonproblem which we now know is caused bycompression of the median nerve in the carpaltunnel of the wrist. In 1947, Brain and twocolleagues described six such cases in middleaged women and Stella was the first to undergodecompression of the median nerve for carpaltunnel syndrome!

In another important report he demonstrated how cervical spondylosis could cause a variety ofneurological disturbances by compression of thecord or spinal roots. Brain and his colleagues,especially Marcia Wilkinson, showed how thedegeneration of the intervertebral disc andsubsequent osteo-arthritic reaction of adjacentvertebrae could result in new bone formation,that impinged upon the nerve roots. In addition,intervertebral discs protruding posteriorly into the cervical canal could reduce canal diameter.These features were demonstrated radiologicallyby injection of opaque medium into the spinalcanal (contrast myelography), and the findingsled to the introduction of a laminectomy astreatment for this condition. Some UnknownProblems of Cervical Spondylosis was publishedin 1963 having been the topic of the Gowersmemorial lecture the previous year.


Walter Russell Brain 1895-1966 Baron Brain of Eynsham: a biography

Russell Brain wasborn in Reading in1895. His father,Walter John Brain,was a solicitor whohad founded asuccessful legalpractice with hisbrother. Hismother, Edith AliceSmith, was thedaughter of thearchitect Charles

Smith who had served the city of Reading twiceas Mayor. The young Russell Brain attended agood preparatory school in Reading and won ascholarship to Mill Hill, from where, intending acareer in law, he read Classics. Realising he wasbetter suited to science, he found that a changeof course was not allowed and was persuaded tostudy history instead. He left school without theeducation he had sought but well known for hiswider interests: a keen supporter of the literaryand debating society, and of the photographicsociety, and secretary of the natural historysociety. This breadth of interest was to be aremarkable feature of his future public life.

The following year, he studied at ReadingUniversity College and then went up to NewCollege, Oxford to read history in 1914, but thiswas the year that war was declared. Disapprovingof war, he became involved in fundraising forBelgian refugees who had fled to England andwere in need of food and shelter. He and a friend,Rev. P N Harrison, held the second ‘flag day’ inEngland to raise money for their plight. He thenwent up to Oxford, where after his first year, quite

unmotivated, he failed his prelims. He laterreflected ‘I have never been able to rememberhistory: my mind being more suited to logicalrelationships.’ This called for a change indirection, and a month later, Brain joined theFriends Ambulance Unit, a Quaker organisation.After travelling to a military hospital in York, heused his experience of photography and a bookabout x-rays to become an orderly in the x-raydepartment. He later transferred to the x-raydepartment in King George Hospital where hemet his future wife, Stella Langdon-Down. Stellacame from a well-known medical family, and wasthe grand-daughter of the distinguished LondonHospital physician John Langdon Down, whodescribed the eponymous Down’s syndrome. It was Stella who encouraged Russell to studymedicine and so, taking her advice, he joinedevening classes at Birkbeck College in zoology,botany, physics and chemistry, and subsequentlypassed the London M.B. In January 1919, hereturned to New College as a medical student,and passed the Oxford B.M., having beenawarded the Theodore Williams’ Scholarship inphysiology. In September 1920 he married Stellaand was awarded the Price Entrance Scholarshipto train at the London Hospital, where his father-in-law had trained and worked. He qualified B.M.B.Ch (Oxon) in December 1922.

At the recently established medical unit of theLondon Hospital in Whitechapel, Brain begantraining under the supervision of the FirstAssistant, George Riddoch. Riddoch was anexpert in war injuries of the nervous system, andintroduced Brain to clinical neurology. At thetime there was growing interest in ‘the newpsychology’ – a psychopathology based on the


documenting which books were worthwhile(some of which he would recommend to hispatients) and kept several notebooks ofquotations that he would use for after-dinnerspeeches, which were always carefully preparedand rehearsed.

His poems and verses were printed privately in1962, and he published a number of volumes ofcritically acclaimed essays including SomeReflections on Genius, reviewed by one critic as a‘pithy, learned and very readable’ exploration ofintellect. In this essay he likened the intellectualtrajectories of the poet and the scientist in theirsearch for inspiration and discovery, bridging thetwo worlds he inhabited. The Nature ofExperience summarised a series of Riddellmemorial lectures that Brain gave in 1958,describing the processes of perception and themechanisms of hallucination and illusion, areflection of his fascination with the mind. In1957, he wrote Tea with Walter de la Mare, asmall book recollecting conversations with thepoet, which was deemed ‘one of those whichwould retain a place on the shelf of the elect’ by a reviewer.

In the public eye, Russell Brain was a trulyexceptional clinician, statesman, philosopher,writer and poet, but behind the scenes he was adevoted husband and father to his three children,Christopher, Michael and Janet, and a loyalmember of the Society of Friends. Asked to whathe owed his success, Brain would answer that,firstly ‘it would be genes a long way ahead ofother factors’, and then secondly his wife, whoencouraged him to study medicine andsupported him throughout his life.

Morag Brothwell, Christopher Brain, Gavin Giovannoni and Michael Swash

References Pickering, G.W. Walter Russell Brain First BaronBrain of Eynsham. 1985-1966. Biogr. Mems Fell.R. Soc. 1968 14, 61-82

Osmond, H. Some Reflections on Genius. The Canadian Medical Association Journal1961: 85; 756-757

http://www.jstor.org/pss/25410717 –Obituary in BMJ

Autobiographical Notes by Lord Brain


Walter Russell Brain 1895-1966

Brain, with a team at The London Hospital,especially Ronald Henson and Henry Urich, were among the first to describe paraneoplasticsyndromes. In 1951, Brain, Greenfield andDaniel described the degeneration of thecerebellum and spinal cord in association withcancer of the lung and ovary, pathology whichcould not be explained by metastasis or infection.They collected data from forty-three cases withwidely varying neurology, includingneuromuscular lesions and dementia. Theseobservations led to the development at theLondon Hospital of a Unit for the Investigation ofcarcinomatous neuropathies, of which Brain wasdirector until his death, and in 1964 he andRaymond Adams proposed the first classificationof these paraneoplastic disorders.

In addition to his outstanding contribution to thefield of neurology, Brain was well-known for histhoughtful statesman-like nature and for hissense of fairness, perhaps deriving from hisQuaker background. He played a major role inthe early development of the National HealthService, in the Royal College of Physicians and inother influential Committees of the day, offeringhis succinct and insightful analyses on a widenumber of issues. He began by serving on theHospitals Committee and Journal Committee ofthe British Medical Association. He was alsosecretary of the London Hospital Medical Counciland became its chairman at a difficult timeduring the Second World War, when it wasnecessary to assert the interests of medical staffaway on active service. In 1950 he was electedPresident of the Royal College of Physicians, aposition he held until 1957. Under Lord Moran,the Royal College had become influential in

medical politics. Brain also became one of theleading medical statesmen of his time, involvedin any matter where the interests of the publicwere relevant to or affected by the medicalprofession. In this capacity, he was appointed toa number of Royal Commissions including thaton Marriage and Divorce in 1952, and on MentalCertification and Detention in 1954. Here heplayed a vital role in improving conditions forpeople with mental health problems. Thepresent law on drug addiction is also largelybased on the recommendations of his committeeon drug addiction in 1966. In 1963, he was alsoelected President of the British Association forthe Advancement of Science, a great honour to a physician still in active practice. He wasparticularly honoured by his election toFellowship of the Royal Society in 1964, a majorachievement for a clinician not engaged directlyin scientific work, and was a member of theCouncil of the Royal Society in 1965. Hiscontributions to medicine and to society ingeneral were recognised by his appointment to the Order of Knights in 1952, and then as aBaronet in 1954, and a Baron in 1962, leading to his entry into the House of Lords. He was anhonorary fellow of New College, Oxford, as well as numerous universities in this country andabroad, and was President of the Association of Physicians in 1956 and of the Association ofBritish Neurologists in 1960.

Given these many responsibilities and accolades,it is remarkable that Brain maintained so manyinterests outside the medical arena. He was akeen bird-watcher, gardener and photographerand was well-known for his love of literature andphilosophy. He read widely, carefully



Walter Russell Brain 1895-1966Bibliography


PAPERS1922-23. (With G. RIDDOCH.) Case of right fronto-parietal tumour; cracked-pot percussion note

over right frontal bone; left palmar reflex. Proc. Roy. Soc. Med. 16 (Sect. Neurol.), 84. 1923. Epidemic hiccup and encephalitis lethargica. Brit. med. J. 2, 78. 1925. The mode of inheritance of hereditary ataxia. Quart. J. Med. 18, 351. 1925. A clinical study of increased intracranial pressure in 60 cases of cerebral tumour.

Brain, 48, 105. 1926. On the rotated or 'cerebellar' posture of the head. Brain, 49, 61. 1926. The inheritance of epilepsy. Quart. J. Med. 19, 299. 1926. The nervous symptoms of insulin hypoglycaemia in rabbits contrasted with the convulsions

induced by cocaine. Quart. J. Exper. Physiol. 16, 43. 1927. The association of low blood cholesterol with the occurrence of fits in epileptics. Lancet, 2,

325. 1927. On the significance of the flexor posture of the upper limb in hemiplegia, with an account of

quadrupedal extensor reflex. Brain, 50, 113. 1927. Heredity in simple goitre. Quart. J. Med. 20, 303. 1928. Posture of the hand in chorea. Lancet, 1, 439. 1928. The treatment of the sequels of head injury. Lancet, 1, 668. 1928. The use of hypertonic solutions in the treatment of increased intracranial pressure. Brit.

med. J. 1, 86. 1928. The treatment of tic. Lancet, 1, 1295. 1928. Facial naevus: Tumour of the pons, ?angioma. Proc. Roy. Soc. Med. 21, 1319. 1928. (With G. RIDDOCH.) Diseases of the brain and skull. In A textbook of surgical diagnosis

(edited by A. J. Walton), 1, 462. 1929. (With M. LANGDON-DOWN.) Time of day in relation to convulsions in epilepsy. Lancet, 1,

1029. 1929. (With D. HUNTER & H. M. TURNBULL.) Acute meningo-encephalitis of childhood. Lancet,

1, 221. 1929. The cholesterol of the blood plasma in epilepsy. Lancet, 2, 12. 1929. The therapeutic uses of Luminal. Lancet, 2, 867. 1930. (With C. I. SCHIFF.) Acute meningo-encephalitis associated with herpes zoster. Lancet, 2,

70. 1930. Pain in the leg. Practitioner, 125, 731. 1930. Exophthalmos of central origin. Brit. med. J. 2, 937.

1930. Disseminated sclerosis: Critical review. Quart. J. med. 23, 343. 1931. (With R. D. CURRAN.) The grasp-reflex of the foot. Proc. Roy. Soc. Med. 24, 43. 1931. Zoster, varicella and encephalitis. Brit. med. J. 1, 81. 1932. (With R. D. CURRAN.) The grasp-reflex of the foot. Brain, 55, 347. 1932. Minor mental disorders. Practitioner, 129, 130. 1932. The functions of the sympathetic nervous system. Proc. Roy. Soc. Med. 25, 105. 1933. (With H. CAIRNS.) Aural vertigo. Treatment by division of eighth nerve. Lancet, 1, 946. 1933. On the diagnosis of pain in the upper limb. Clin. J. 62, 17. 1934. Some varieties of acute optic and retrobulbar neuritis. Ophthal Soc. Trans. 54, 221. 1934. Inheritance of epilepsy. In The chances of morbid inheritance. (Ed. by C. P. Blacker.)

London: H. K. Lewis & Co.1935. The anaemias in relation to life insurance. Trans. Ass. Med. Soc. (London, 1936). p. 39. 1935. Epilepsy. Postgrad. med. J. 11, 145. 1936. Prognosis of disseminated sclerosis. Lancet, 2, 866. 1936. Exophthalmos following the administration of thyroid extract. Lancet, 1, 182. 1937. Exophthalmos ophthalmoplegia. Trans. Ophthal. Soc. 57, 107. 1937. Epilepsy. Brit. Encyclopaedia of Med. Practice, p. 97. 1937. Intrinsic diseases of the spinal cord. In Oxford loose-leaf medicine. (Ed. by H. A. Christian.)

Chap. 14, 328. New York. 1937. Tumours of the spinal cord and other lesions causing compression. In Oxford loose-leaf

medicine. (Ed. by H. A. Christian.) Chap. 16, 447. New York. 1937. (WithJ. G. GREENFIELD.) Epiloia. Brit. Encyclopaedia of Med. Practice, 5, 117. 1937. (With D. S. RUSSELL.) The neurological sequelae of spinal anaesthesia. Proc. Roy. Soc.

Med. 30, 1024. 1938. The diagnosis of epilepsy beginning in adult life. Postgrad. med. J. 14, 116. 1938. Two cases of Graves's disease with muscular atrophy. Guy's Hosp. Repts. 88, 125. 1938. (With H. M. TURNBULL.) Exophthalmic ophthalmoplegia. Quart. J. Med. 7, 293. 1939. Speech defects. Brit. Encyclopaedia of Med. Practice, 11, 294. 1939. Sleep: Normal and pathological. Brit. med. J. 2, 51. 1939. Exophthalmos in Graves's disease. Lancet, 2, 1217. 1941. Brain and mind. Lancet, 1, 745. 1941. Visual object agnosia with special reference to the Gestalt Theory. Brain, 64, 43.




1941. Visual disorientation with special reference to lesions of the right cerebral hemisphere.Brain, 64, 244.

1942. Rehabilitation after injuries to the central nervous system. Proc. Roy. Soc. Med. 35, 302. 1943. (With J. G. GREENFIELD & D. W. C. NORTHFIELD.) A case of atypical Lindau's disease. J.

Neurol. 6, 32. 1943. Thyrotoxicosis in relation to ophthalmology. Trans. Ophth. Soc. 63, 3. 1943. Discussion on recent experiences of acute encephalomyelitis and allied conditions.

Proc. Roy. Soc. Med. 36, 319. 1945. Exophthalmos and endocrine disturbance. Proc. Roy. Soc. Med. 38, 666. 1945. Speech and handedness. Lancet, 2, 837. 1947. (With A. D. WRIGHT & M. WILKINSON.) Spontaneous compression of both median

nerves in the carpal tunnel. Lancet, 1, 277. 1947. Malnutrition of the nervous system. Brit. med. J. 2, 763. 1947. Some observations on visual hallucinations and cerebral metamorphopsia. Acta Psychiat.

et Neurol. 46, 28. 1948. Brachial neuralgia. Lancet, 1, 393. 1948. Rupture of the intervertebral disc in the cervical region. Proc. Roy. Soc. Med. 41, 509. 1948. (With J. G. GEEENFIELD & D. S. RUSSELL.) Subacute inclusion encephalitis. Brain, 71,

365. 1948. Amyotrophic lateral sclerosis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 30. 1948. Disseminated sclerosis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 222. 1948. Encephalitis lethargica. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 279. 1948. Epilepsy. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 286. 1948. Myasthenia gravis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 559. 1948. Paralysis agitans. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 615. 1948. Paraplegia. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 616.1948. Poliomyelitis and polioencephalitis, acute. In Index of Treatment. (Ed. by Sir Robert

Hutchison.) 13th ed. p. 645. 1948. Tabes dorsalis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 808. 1948. Tics. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 839.

1948. Wry-neck, spasmodic. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 905.

1949. Psychiatry and neurology. In Modern practice in psychological medicine. (Ed. by J. R. Rees.) London: Butterworth & Company, p. 135.

1949. Modern views on epilepsy. Ass. Med. Soc. p. 197. 1950. Grasp reflex of the foot. Medicina Clinica, 5, 293. 1950. (With J. G. GREENFIELD.) Late infantile metachromatic leuco-encephalopathy with

primary degeneration of the interfascicular oligodendroglia. Brain, 73, 291. 1950. The concept of the schema. In 'Neurology and psychiatry': In Perspectives in Neuro-

psychiatry. (Ed. by Derek Richter.) London: H. K. Lewis & Co. 1950. The cerebral basis of consciousness. Brain, 73, 465. 1951. Mind and matter. Lancet, 1, 863. 1951. (With J. G. GREENFIELD & D. SUTTON.) Epiloia. Brit. Encyclopaedia of Med. Practice.

2nd ed. 5, 266. 1952. The management of endocrine exophthalmos. Proc. Roy. Soc. Med. 45, 237. 1952. (With D. W. C. NORTHFIELD & M. WILKINSON.) The neurological manifestations of

cervical spondylosis. Brain, 75, 187. 1954. Spondylosis: the known and the unknown. Ann. Rheum. Dis. 13, 2; and Lancet, 2, 687. 1954. Loss of visualization. Proc. Roy. Soc. Med. 47, 288. 1954. Spondylose cervicale. Revue Neurologique, 90, 209. 1954. Les affections dues a la Thesaurismose de Kerasine. Acta Neurol et Psychiat. Belgica, p.

297; and Reports 5th Int. Neurological Congress, Lisbon, 1953, Vol. 1. 1954. Cervical spondylosis. Ann. Int. Med. 41, 439. 1954. Cerebral vascular disorders. Lancet, 2, 831. 1954. Aphasia, apraxia and agnosia. In Neurology by S. A. K. Wilson, 3, 1413. 1955. Cortisone in exophthalmos. Lancet, 1, 6. 1955. Mind and body. Brain, 78, 669. 1955. Exophthalmic ophthalmoplegia. Trans. Ophthal. Soc. 75, 351. 1955. Semantics: A symposium. Arch. Linguist. 8, 1. 1956. Perception and imperception. The Thirtieth Maudsley Lecture. J. Ment. Sci. 102, 221. 1956. Pain. Physiotherapy, 42, 293. 1956. Some aspects of the neurology of the cervical spine. J. Faculty Radiol. 8, 74.

Commemorative Booklet 1514 Inaugural Lord Brain Memorial Lecture


1956. Cerebro-vascular disease. Anatomical and physiological factors in treatment. Proc. Roy. Soc. Med. 49, 164.

1957. Differential diagnosis of acroparesthesiae. Gen. Practnr., Lond. 15, 94. 1957. (With M. WILKINSON.) The association of cervical spondylosis with disseminated sclerosis.

Brain, 80, 456. 1957. Order and disorder of the cerebral circulation. Lancet, 2, 857. 1958. (With M. WILKINSON.) Cervical arthropathy in syringomyelia, tabes dorsalis and diabetes.

Brain, 81, 275. 1958. The physiological basis of consciousness. A critical review. Brain, 81, 426. 1958. (With R. A. HENSON.) Neurological syndromes associated with carcinoma.

The carcinomatous neuropathies. Lancet, 2, 971. 1958. Neurology of the cervical spine. London Hosp. Gaz. 61, II (Oct.).1958. The carcinomatous neuropathies. 5th Int. Congress of Intern. Med., Philadelphia. 1958. Neurology of the cervical spine. Trans. Coll. Phys. Surg. and Gynaecolog., S. Africa, 2, 33. 1958. Hughlings Jackson's ideas of consciousness in the light of today. In The brain and its

functions. Blackwell Scientific Pubns. p. 83. 1959. Pathogenesis and treatment of endocrine exophthalmos. Lancet, 1, 109. 1959. Cervical spondylosis. Cecil-Loeb Textbook of medicine, 1959, 10th Ed. 1950.

Philadelphia and London: W. B. Saunders & Co. 1959. Posture. Brit. med. J. 1, 1498. 1959. (With M. WILKINSON.) The extensor plantar reflex and its relationship to the functions

of the pyramidal tract. Brain, 82, 297. 1960. The myopathies of late onset. Swiss med. J. 90, 904. 1961. The neurology of language. Brain, 84, 145. 1961. Consciousness and the brain. Bewusstseinsstorungen. (Ed. by H. Staub and H. Tholen.)

Stuttgart: G. Thieme. 1962. Vertigo of central origin. Proc. Roy. Soc. Med. 55, 361. 1962. Recent work on the physiological basis of speech. Advanc. Sci. Lond. 19, 207. 1962. Diagnosis, prognosis and treatment of endocrine exophthalmos. Trans. Ophthal. Soc. 82,

223. 1962. The assessment of pain in man and animals. Proceedings of International Symposium, 1961. (Ed. by C. A. Keele and Robert Smith.) p. 3. London: Universities Federation for Animal

Welfare.

1963. The language of psychiatry. Brit. J. Psychiat. 109, 4. 1963. Neurological complications of neoplasms. Lancet, 1, 179. 1963. Some unsolved problems of cervical spondylosis. Brit. med. J. 1, 771. 1963. Cervical spondylosis. Cecil-Loeb Textbook of medicine, 11th Ed., 1703. Philadelphia

and London: W. B. Saunders & Co. 1963. Some reflections on brain and mind. Brain, 86, 381. 1964. Cerebro-vascular disease as a cause of falls in the elderly. Geront. Clin. 6, 167. 1964. (With BARBARA ALLEN.) Encephalitis due to infection with Toxocara canis. Lancet, 1,

1355. 1964. Science and behaviour. Advanc. Sci. 21, 91. 1964. Psychosomatic medicine and the brain-mind relationship. Lancet, 2, 325. 1964. Human mind in 1984. New Scientist, 21, 806. 1964. (With A. S. PARKS & P. M. F. BISHOP.) Some medical aspects of oral contraceptives.

Lancet, 2, 1329. 1965. Science and antiscience. Science, 148, 192. 1965. (With M. WILKINSON.) Subacute cerebellar degeneration in patients with carcinoma.

In Remote effects of cancer on the nervous system. (Ed. F. H. Norris and Lord Brain.) New York: Grune and Stratton.

1965. (With R. D. ADAMS.) A guide to the classification and investigation of neurological disordersassociated with neoplasms. In Remote effects of cancer on the nervous system.(Ed. F. H. Norris and Lord Brain.) New York: Grune and Stratton.

1965. Subacute cerebellar degeneration associated with neoplasms. Brain, 88, 465. 1965. Motor neurone disease as a manifestation of neoplasms (with a note on the course of

classical motor neurone disease). Brain, 88, 479. 1965. Structure of the scientific paper. Brit. med. J. 2, 868. 1965. Drug dependence. Nature, Lond. 208, 825. 1965. Perception: A trialogue. Brain, 88, 697. 1966. Hashimoto's disease and encephalopathy. Lancet, 2, 512. 1966. Disorders of memory. Neurology, 14, No. 2. 1966. Medical issues in abortion law reform. Lancet, 1, 727.



CONTRIBUTIONS TO SYMPOSIA1958. Cerebral vascular disease. Transactions of the 2nd Conference held under the auspices of

the American Heart Association. New York and London: I. S. Wright and C. H. Millikan. 1958. The neurological basis of behaviour. A CIBA Foundation Symposium. (Ed. G. E. W.

Wolstenholme and C. M. O'Connor.) London: J. & A. Churchill. 1959. Significant trends in medical research. CIBA Foundation 10th Anniversary Symposium.

(Ed. G. E. W. Wolstenholme, C. M. O'Connor and M. O'Connor.) London: J. & A. Churchill. 1963. Man and his future. A CIBA Foundation volume. (Ed. Gordon Wolstenholme.)

London: J. & A. Churchill. 1964. Statement of the problem. Disorders of language. CIBA Foundation Symposium.

(Ed. by A. V. S. de Reuck and M. O'Connor.) London: J. & A. Churchill.

NON-MEDICAL PUBLICATIONS1927. Galatea or thefuture ofDarwinism. London: Kegan, Paul, Trench, Trubner & Company. 1944. Man, society and religion. London: George Allen & Unwin. 1950. Speech and thought. In The physical basis of mind. (Ed. by P. Laslett.) Oxford: Basil

Blackwell. 1951. Mind, perception and science. Oxford: Blackwell Scientific Publications. 1952. The contribution of medicine to our idea of mind. Cambridge University Press. 1955. Language, meaning and mind. Nature, Lond. 176, 673. 1957. Tea with Walter de la Mare. London: Faber & Faber, 2nd impression 1957, 3rd

impression 1958. 1959. The nature of experience. Oxford University Press. 1959. Science, philosophy and religion. Cambridge University Press. 1960. Some reflections on genius, and other essays. London: Pitman Medical Publishing

Company Limited, 2nd impression 1961. 1961. Poems and verses. Privately printed. 1961. Body, brain, mind and soul. In The humanist frame. (Ed. Julian Huxley.) London:

George Allen & Unwin. 1964. Doctors past and present. London: Pitman Medical Publishing Company Limited. 1964. Science and behaviour. Presidential address to the British Assn. Advancement of Science,

p. 211964. Retsina. Privately published by Staples, Printers. 1966. Science and man. London: Faber & Faber.

MEDICAL BOOKS1929. (With E. B. STRAUss.) Recent advances in neurology. London: J. & A. Churchill, Ist

Ed.; 2nd Ed. 1930; 3rd Ed. 1934; 4th Ed. 1940; 5th Ed. 1945; Italian Ed. 1949; 6th Ed. 1955; Spanish Ed., published in Madrid (1931).

1933. Diseases of the nervous system. London: Oxford University Press, Ist Ed.; 2nd Ed. 1940 3rd Ed. 1947; 4th Ed. 1951; 5th Ed. 1955; Spanish Ed. (Argentine) 1958;

Italian Ed. (Rome) 1958. 1960. Clinical neurology. London: Oxford University Press, Ist Ed. 1960; 2nd Ed. 1964. 1961. Speech disorders: aphasia, apraxia and agnosia. London: Butterworth. 1965. Speech disorders. London: Butterworth. 1966. Science and man. London: Faber & Faber.

GENERAL AND HISTORICAL1935. Hughlings Jackson. London Hosp. Gaz. 38, 212. 1943. Lord Monboddo: Evolutionist and Anti-Johnsonian. London Hosp. Gaz. Dec. p. 6. 1952. The neurology of John Hunter's last illness. Brit. med. J. 2, 1371. 1953. The need for a philosophy of medicine. Lancet, 1, 959. 1953. Vital statistics and the doctor. Brit. med. J. 2, 1283. 1953. The future of clinical neurology. Lancet, 2, 1109. 1953. The doctor in the modern world. St George's Hosp. Gaz. 39, 5. 1955. Language, meaning and mind. Nature, Lond. 176, 673. 1956. Public opinion and mental illness. Lancet, 2, 1149. 1957. Address to the Association of Physicians of Great Britain and Ireland at its 50th

Annual General Meeting (1956). Quart. J. Med. 26, 101. 1957. Harvey: The ocular philosopher. Lancet, 1, 1235. 1957. The treatment of pain. S. African med. J. 31, 973. 1957. Thomas Lawrence, M.D., P.R.C.P. Medical History, 1, 293. 1957. Conversations with Sherrington. Lancet, 2, 1109. 1958. Neurology: past, present and future. Brit. med. J. 1, 355. 1958. The need for experiment. Lancet, 2, 1322. 1959. William Harvey, neurologist. Brit. med. J. 2, 899. 1960. Socrates on the Health Service, Dialogues of today. London: The Lancet Ltd.



The Neurological Tradition at the LondonProfessor Michael Swash

1963. The doctor's place in society. The London School of Economics and Political Science. 1967. Medicine and government. Tavistock Publications.

ReferencesTitle: Walter Russell Brain First Baron Brain of Eynsham. 1895-1966 Author(s): George W. Pickering Source: Biographical Memoirs of Fellows of the Royal Society, Vol. 14, (Nov., 1968), pp. 61-82 Publisher(s): The Royal Society Stable URL: http://www.jstor.org/stable/769439

In his Schorstein Lecture given at the London in 1959, Lord Brain addressed this subject,publishing it in the Lancet in the same year. His lecture was subtitled “on the importance of being thirty”, that being the mean age ofconsultant appointments in Neurology at theLondon until post-war bottlenecks in NHSpreferment resulted in a surfeit of SeniorRegistrars, many approaching 40 years of agebefore appointment to the consultant grade.Brain’s thesis was that a neurologist’s best workis commenced before the age of 30 years, andthe lecture proved influential.

Beginnings The London Hospital was founded in 1740,famously after a meeting in the Feathers publichouse in the City. From the start there seems tohave been an interest in neurological illness.John Andrée, the first physician appointed to thestaff in 1740, published a two-volume book onepilepsy and related disorders in 1753. JohnCooke (1756-1823), also an early physician tothe hospital, published his ‘Treatise on NervousDiseases’, one of the first comprehensivetextbooks of neurology written in English, in1820. His book is organized in three generalsections; Epilepsy, Apoplexy and Palsy, withextensive historical introductions to eachsection.

James ParkinsonJames Parkinson (1755-1824) describedparalysis agitans in a now scarce monograph in 1817. He had been a dresser at the LondonHospital for six months in 1776, and afterwardswas a practitioner in East London, maintainingclose professional relations with the London.

His monograph provides a remarkably completedescription of the disease, except for theomission of rigidity. It was only with the advent ofmore complete schemata of clinical examinationthat this feature was later recognized by Jean-Martin Charcot, in Paris, and it was Charcot whofirst used the eponymous nomenclature thatremains in use today. Parkinson himself, aprolific pamphleteer and agitator for politicalreform, often unpopular with the authorities ofthe day was also a distinguished geologist andfossil collector, and the founder of the RoyalGeological Society.

William John LittleIn 1834 WJ Little (1810-1894), a surgeon with a special interest in orthopaedics, describedcerebral palsy and recognized its associationwith birth trauma and hypoxia. He was anapothecary's apprentice before entering medicalschool at the London Hospital at the age of 18.He was admitted to the Royal College ofSurgeons in 1832. Little introduced tenotomy to Britain for the management of talipes, atechnique he had learned in Germany, andfounded the National Orthopaedic Hospital inLondon.

Jonathan Hutchinson and Hughlings JacksonSir Jonathan Hutchinson (1828-1913) wasinfluential and productive in many areas ofmedicine throughout his long life. Hisneurological contributions included papers on neurosyphilis, optic neuritis (not thendistinguished from papilloedema), thesyndromes of internal carotid artery aneurysmsand carotid occlusion, and on torticollis. Hecontributed a seminal paper on the pupils to the

London Hospital, but Head was unable topersuade the House Committee to designate hisrequired total of 100 beds and suitable staff tothe project, and the opportunity passed when heretired, aged only 58 years, with Parkinson’sdisease.

Russell Brain and laterAfter Head retired, W Russell Brain (1895-1966)joined Riddoch on the staff, quickly establishinga reputation as a skilled and knowledgeableclinician. He wrote extensively on neurologicaltopics, including defining contributions on carpaltunnel syndrome and with Marcia Wilkinson, onthe neurological complications of cervicalspondylosis, including its differential diagnosisfrom multiple sclerosis. His hugely influentialTextbook of Neurological Disorders was firstpublished in 1933, and went through fivepersonally written editions until 1962. Latereditions have been multi-authored. With RonaldHenson (1915-1994), and Henry Urich, hedescribed and classified the paraneoplasticsyndromes. Brain had a national reputation as adiagnostician. Although essentially a very privateman, his teaching rounds, serious affairs thoughthey were, were highly valued. When Brainretired in 1962 Christopher Earl, another superbclinician and teacher, joined Henson in theneurological unit. Alan Ridley was appointedwhen Earl resigned and Michael Swash, aLondon Hospital graduate trained both at theLondon and in the USA, who became the firstProfessor of Neurology in the Medical School in1993, was appointed as third neurologist in1972. The merger with Barts induced a majorand long-overdue increase in staffing levels in the department. Gavin Giovannoni succeeded

Michael Swash as Professor of Neurology, with an expanded department, in 2006.

NeuropathologyHM Turnbull (1875-1955), renowned as a pathologist, very much encouragedneuropathology, then in its infancy. He followedup Fearnsides’ observations on intracranialaneurysm in work that enabled CharlesSymonds, working at Guys and Queen Square, to describe the clinical diagnosis of subarachnoidhaemorrhage. With James MacIntosh (1882-1948) Turnbull described the clinical andpathological features of post-vaccinialencephalomyelitis. MacIntosh and Sir Paul Fildes(1882-1971), then working in the Department ofMicrobiology at the London, confirmed Noguchi’sdiscovery of the treponemal basis of syphilis, adiscovery that led to a revolution in neurologicaldiagnosis, causing the reclassification of anumber of syndromes previously misattributed tosyphilitic infection. Dorothy Russell (1895-1983)succeeded Turnbull as Professor of MorbidAnatomy in 1944 – the first woman to achieveprofessorial status in pathology in Europe. Shehad been one of the first lady medical students at the London, and had trained there and later inMontreal with Wilder Penfield, who had learnedsilver stain technology from Dr Pio del RioHortega, Ramon y Cajal’s former student andcolleague in Madrid. With the outbreak of war in1939 Russell moved to Oxford where Hortegawas working with Hugh Cairns in the militaryNeurosurgical Head Injury Unit at St High’sCollege. Ronald Henson was also relocated to StHugh’s during the bombing of London; RussellBrain was relocated with JG Greenfield, theneuropathologist, Chase Farm Hospital in North


first volume of Brain in 1878. He was a foundermember and President of the NeurologicalSociety of London – later subsumed into theRoyal Society of Medicine. It was he whoencouraged the young John Hughlings Jackson(1836-1911) to study neurology. Jackson is nowwidely recognized as perhaps the most original ofthe “founders of neurology”. Like Hutchinson,Jackson was a graduate of the York MedicalSchool under Thomas Laycock. WithHutchinson’s support and influence Jacksonjoined the staff of the London in 1859, as well asthe newly formed Hospital for the Paralysed andEpileptic at Queen Square. Jackson codifiedclinical phenomena, especially eye movements,epilepsy, language disorders, disorders of motorcontrol, and right hemisphere functions,interpreting them as positive or negativephenomena in the light of Darwinian evolution. In this approach he was much influenced by hisfriend, Herbert Spencer, the philosopher. Hisconcept of levels of function in the brain wasespecially influential, extending also intoEuropean psychiatry.

Warren TayWarren Tay (1844-1927), a surgeon anddermatologist with an interest in disorders of the eyes, made the first description of thecharacteristic fundoscopic appearance of Tay-Sachs disease in 1881, recognizing the familialcausation of the disease in 1884, when theophthalmoscope was still a novel instrument.Bernard Sachs, a New York neurologist,described the pathology in 1887.

Henry HeadHenry Head (1861-1940), perhaps the firstclinical neuroscientist, was educated, as weremany of his generation, in both England andGermany, before his appointment at the London(Queen Square having declined to appoint him).He became one of the leading figures inEuropean neurology, making major contributionsto knowledge of the segmental dermatomaldistributions on the body, to visceral sensationand, with WHR Rivers, to sensory physiologyitself, introducing von Frey’s hairs into clinicaland research practice in Britain. His observationson the recovery of sensation after nerve injurywere made following section of his ownsuperficial radial nerve by his colleague at theLondon, Sir James Sherren who, himself, wrotean important monograph on peripheral nerveinjuries and their management (1908). With hisneurological colleagues at the London, GeorgeRiddoch (1888-1947) and Theodore Thompson(1878-1938), he published extensively on spinalcord injury. Head made a major contribution tounderstanding aphasia and to theneurophysiology of language (1926),painstakingly studying patients brain-injured inthe First War in relation to their brain lesions. WithEG Fearnsides (1883-1919), in the Departmentof Morbid Anatomy, he studied neurosyphilis.Fearnsides, continuing to work with HM Turnbullin Morbid Anatomy, made the firstcomprehensive description of intracerebralaneurysms in 1916, but his career was tragicallycut short in a boating accident aged only 36years. Head was selected by Sir Walter Fletcher,Secretary of the newly formed Medical ResearchCouncil, as a suitable candidate to develop thefirst academic unit of medicine in Britain, at the


The Neurological Tradition at the London

assistance of Leo Honigsberger, who had aninterest in epilepsy monitoring,. Donald Scottdeveloped this department with Pamela Priorfrom the early 1960s. Electromyography andnerve conduction studies were provided by KitWynn-Parry in the Department of PhysicalMedicine. Later, as this specialty developed,these investigations joined EEG in theDepartment of Clinical Neurophysiology.Radiotherapy was in active use before theSecond War, and radioisotope brain scanningpreceded the advent of CT and then MR brainimaging in the 1970s and 1980s respectively.Rehabilitative services were provided incollaboration with the relevant related specialtiesbeginning in the nineteenth century.


London. Dorothy Russell transferred this silvertechnology to the London and used it to greateffect with Lucien Rubinstein (1924-1983) intheir defining monograph “Tumours of theNervous System”, a book that ran through fiveeditions and continues to this day, long after bothits original authors have passed away. In addition,Russell made huge contributions, often withCrooke, to knowledge of the pituitary gland, to theclassification and causation of hydrocephalus,and to general neuropathology. When Rubinsteinmoved to the USA (first to Columbia, and then toStanford), Henry Urich took over theneuropathological department continuing thetradition of expertise in cerebral tumours andbrain malformations. He was followed by CarlScholtz, and then by Jennian Geddes.

Sir Hugh Cairns and Neurosurgery:The neurosurgical unit at the London wasfounded by Cairns (1896-1952), althoughneurosurgical procedures were of coursefrequently performed before his appointment in1926. Cairns, an Australian Rhodes scholar, firstspent a year in pathology with Turnbull, and thenworked in general and renal surgery at theLondon. Prior to his taking up this appointmentas Neurosurgeon, the Hospital Governors senthim in 1926 to Boston to work with HarveyCushing, so that on his return he could introducethe innovative techniques pioneered by Cushingto Britain. Once the Unit was fully established, in1933, there were hosts of visitors keen to learnthe new methods. In 1938 Cairns was temptedby Lord Nuffield’s offer to join his new School ofMedicine at Oxford as Professor of Surgery,leaving the neurosurgical department at theLondon in the capable hands of his former

student, Douglas Northfield (1902-1976), who was later joined by JV Crawford. Northfielddeveloped pioneering procedures in tumoursurgery, spinal surgery, the management ofhydrocephalus, and epilepsy surgery.Northfield’s book “Surgery of the NervousSystem’ (1973) represented the apogee ofneurosurgical technique and knowledge to thattime. Crawford was succeeded by Tom King,himself a meticulous surgeon with a majorinterest, in collaboration with Andrew Morrison,in acoustic Schwannoma surgery. ES Watkins,the first Professor of Neurosurgery, who broughtnew methods of stereotaxic surgery moved to theLondon from the USA, succeeded Northfield.Fary Afshar, himself a London Hospital graduate,rejoined the London as Neurosurgeon when theneurosurgical unit at Barts closed. He and hiscolleagues were joined by Peter Richardson, whosucceeded Watkins, and by other colleagues.

Related specialtiesAssociated skills and facilities are essential to the practice of a specialty. For neurology andneurosurgery, neuropathology, neuroradiology,clinical neurophysiology, various laboratorystudies, and specialized therapies such asphysiotherapy, occupational therapy, as well asoncology and radiotherapy are pre-requisites tomodern practice. The London was in the forefrontin the provision of these modalities. Skull X-rayswere available before the First War, EEGrecordings using two saline pad Bergerelectrodes were in use for the diagnosis ofepilepsy and cerebral tumours in the 1930s and, after the Second War, a formally constitutedDepartment of Electro-Encephalography wasestablished by Dr Samuel Last, later with the


The Neurological Tradition at the London

Further ReadingClarke-Kennedy AE The London; a study ofthe voluntary hospital system. vols 1 and 2.London, Pitman Medical 1962

Geddes JF. A portrait of the Lady: a life ofDorothy Russell. J Roy Soc Med1997;90:455-461

Haymaker W. Founders of Neurology.Springfield, Illinois. Charles C Thomas 1953

Jacyna LS. Medicine and Modernism.London, Pickering and Chatto 2008

McHenry LC. Garrison’s History of Neurology.Springfield, Illinois, Charles C Thomas. 1969

Morris EW. A history of the London Hospital.London, Edward Arnold. 1926

Swash M. John Hughlings-Jackson: a sesquicentennial tribute. J Neurol, Neurosurg Psychiatry1986 49 981-985

Swash M. Henry Head and the developmentof clinical neuroscience. Brain2008;131:3453-3456

Swash M. And Lord Brain said. PracticalNeurology 2007;7:250-251


Professor Michael Swash MD FCRP FRCPath Barts and The London School of Medicine and Dentistry

Professor John Hardy Reta Lila Weston Institute of Neurological StudiesUniversity College London, Institute of Neurology

Michael Swash isEmeritus Professorof Neurology,Queen MaryUniversity ofLondon, Barts andthe London Schoolof Medicine andDentistry, ProfessorCatedraticoConvidado daDisciplina deNeurologia da

Faculdade de Medicina de Lisboa, Portugal, andHonorary Consultant Neurologist, Barts and theLondon NHS Trust. He trained at the LondonHospital Medical College and at The University ofVirginia School of Medicine, graduating in 1962.He took House Appointments in Neurosurgeryand Medicine was SHO in Medicine at the RoyalUnited Hospital, Bath. He worked in GeneralPractice in Somerset and inner London beforemoving to the USA to train in the residencyprogram in neurology with Dr Joseph M Foleyand Dr Maurice Victor at Case-Western ReserveUniversity, Cleveland, Ohio, and as a Fellow inNeurophysiology at Washington University, StLouis, Missouri.

Returning to London in 1968, he was Registrar in Neurology at the London, and then MRCResearch Fellow in Neuropathology, working onmuscle spindles. He was briefly Senior Registrarat the London before being appointed asConsultant Neurologist in 1972. He also took anacademic position as Honorary Senior Lecturer in Neuropathology in the Department of Morbid

Anatomy of the Medical College. He wasappointed as the College’s first Professor ofNeurology in 1993. He was Medical Director ofthe first wave Trust at the London for three years,after a period of 6 years representing the Hospitalon the Health Authority. For 10 years he wasChairman of the City and East London researchEthics Committee. He served on theNeuroscience Board of the MRC, and was afounder member of the Motor Neurone DiseaseAssociation, where he initiated and later chairedthe Research Committee. He was later Chairmanand President of the MND Association for athree-year term. He has held numerouscharitable and international positions, includingChairmanship of the World Federation ALSResearch Committee. He founded theCommittee’s journal “Amyotrophic LateralSclerosis” and edited it for 8 years. His researchhas centred on clinical neurology, physiologicaland anatomico-pathological aspects of pelvicfloor disorders, including faecal and urinaryincontinence, physiological and pathologicalaspects of neuromuscular disease and,especially. motor neurone disease. He haspublished more than 500 original papers andreports, and 16 books, many in several editions,especially Hutchison’s Clinical Methods, aLondon Hospital classic now more than 100years in continuous publication. He has beenawarded numerous prizes and Lectureships andis the Association of British Neurologists’Medallist for 2010. In his work at the London hehas been privileged to work with many giftedcolleagues and trainees, the latter from manydifferent countries.

John Hardy receivedhis degree inBiochemistry fromLeeds in 1976 andhis PhD fromImperial College inNeuropharmacologyin 1979. He didpostdocs at theMRCNeuropathogenesisUnit and theSwedish Brain

Bank, in Umea, where he started to work onAlzheimer’s disease. In 1985 he took the job ofLecturer in Biochemistry and Molecular Geneticsat St Mary’s Hospital, Imperial College, where hebegan working on the genetics of Alzheimer’sdisease. In 1991 he led the group which foundthe first mutation in the amyloid gene whichcaused Alzheimer’s disease. This finding led himand others to formulate the amyloid hypothesisfor the disease.

In 1992 he moved to the United States, to theUniversity of South Florida. In 1996 he moved to the Mayo Clinic where he became Chair of theDepartment of Neuroscience in 2000. In 1998he was part of the consortium which identifiedmutations in the tau gene in Pick’s disease. In2001 he moved to the NIH to become the Chiefof the Laboratory of Neurogenetics, where he waspart of the group which found triplications in thesynuclein gene caused Parkinson’s disease. He returned to the Department of MolecularNeuroscience at the Institute of Neurology in2007. He has won the Allied Signal, Potamkin,MetLife and Kaul Prizes for his work onAlzheimer’s disease and the Anna MarieOpprecht Prize for his work on Parkinson’sdisease. He has been elected a member of theAcademy of Medical Sciences and has beenawarded an honorary MD by the University ofUmea, Sweden. He was recently made an FRSby the Royal Society in 2009. He has three adultchildren and a grandchild who live in the US.


Professor Andrew Lees FRCP, FMedSci, Reta Lila WestonInstitute of Neurological Studies University College London, Institute of Neurology. First recipient of the Lord Brain Memorial Medal

Brainwashed by the Black Stuff Professor Andrew Lees

Andrew Lees isDirector of the Reta Lila WestonInstitute ofNeurologicalStudies atUniversity CollegeLondon, andProfessor ofNeurology at theNational Hospitalfor Neurology andNeurosurgery,

Queen Square, London. He is Director of theQueen Square Brain Bank for NeurologicalDisorders and the Sara Koe PSP ResearchCentre. He is Associate Director of the UKDementias & Neurodegenerative DiseasesResearch Network and Chairman of the ClinicalStudies Group on Parkinson’s Disease. He is aFellow of the Academy of Medical Sciences andan NIHR Senior Investigator. He is the pastPresident of the Movement Disorders Society,and Former Co-Editor-in-Chief of the MovementsDisorders Journal.

He received the AAN Movement Disorders LifeTime Achievement Award 2006, San Diego, andhe was awarded honorary membership by theMDS in 2010. He is recognised as a Highly CitedNeuroscientist on the ISI “Highly CitedResearchers” database, and is an electedoverseas member of fifteen national neurologicalsocieties. Professor Lees resurrected the use ofsubcutaneous apomorphine as an effectivetreatment for late stage Parkinson’s, and haswritten a biography on Ray Kennedy, the formerEngland football player who tragically developedParkinson’s disease at the age of 35. He isauthor of the monograph “Tics and RelatedDisorders”, and Co-author of “Parkinson’sDisease, The Facts”. He is Chairman of theMedical Advisory Panel of the PSP Associationand an advisor to the UK Medical ResearchCouncil. He also sat on the UK GovernmentNCCC Guideline Development Group forParkinson’s Disease (NICE guidelines). He is a visiting Professor to both the University of Liverpool and Universidade Federal de Ceara,Fortaleza, Brazil.

At least seventy per cent of neuromelanin containing tyrosine hydroxylase immunoreactiveneurones in the ventrolateral zone of the pars compacta of the substantia nigra are lost inParkinson’s disease before bradykinesia appears. This suggests that there must be a period ofcompensation within the nigrostriatal pathway followed by subsequent maladaptive plasticity indownstream motor circuits. A handful of pathological and neuroimaging studies have suggestedthat the disease process may begin in the midbrain about six years before the first motorsymptoms are detectable. In Parkinson’s disease there appears to be a direct correlation betweenthe degree of cell loss in the pars compacta and the severity of motor handicap but this does notseem to apply in post encephalitic Parkinson’s disease or juvenile onset autosomal recessiveParkinsonism where severe neuronal loss can occur in the presence of mild bradykinesia.

Dopamine replacement therapy has significantly improved the quality of life of patients withParkinson’s disease and modestly improved life expectancy resulting in the emergence of visualhallucinations and dementia as common late stage morbidities. It seems probable that thesesymptoms are due to the spread of the disease into the cerebral cortex, although the role ofneocortical Lewy body formation in symptom causation is unclear. Involvement of thedopaminergic system is unlikely to be responsible for these disabling mental complications andare unlikely to be corrected by foetal or stem cell implantation. The finding of Lewy bodies in about5% of graft cells which have survived more than a decade in the host brain has posed newchallenges for stem cell programmes in Parkinson’s disease and led to the possibility that prion-like mechanisms may be important in disease progression.

Selective vulnerability of long ascending projection catecholaminergic brain stem neurons is astriking feature of Parkinson’s disease but some neuronal groups are left relatively intact. Theventro tegmental TH Immunoreactive neurons of the A10 group which project to the nucleusaccumbens are only mildly damaged but may be involved in the common finding of anhedonia in Parkinson’s disease. The wide spectrum of affective and impulsive behaviours seen in patientsparticularly on oral dopamine agonists may result from subversion of a relatively intact ventralstriatum by dopaminergic drugs.


Neuroscience at Barts and The London

Neuroscience is a partnership between Bartsand The London School of Medicine andDentistry and Barts and The London NHS Trust.

Barts and The London School of Medicine andDentistry provides international levels ofexcellence in research and teaching. The 2008Research Assessment Exercise results showedthe School joining Oxford, Cambridge, ImperialCollege and University College London in the topfive research-active medical and dental schoolsin England. According to rankings published inthe Times Higher Education, Barts and TheLondon scored consistently in the top five in theUK. At the heart of the School’s mission liesworld class research. During the last five years,the School has implemented a focusedprogramme of recruitment of leading researchgroups from the UK and abroad, together with a£100 million investment in state-of-the-artresearch facilities.

Barts and The London NHS Trust has beenconsistently rated amongst the top teachinghospital trusts in the UK for clinical excellence.The Trust will benefit significantly through the £1 billion Private Funding Initiative that willtransform Barts and The Royal London Hospitalsinto one of the largest hospital complexes inEurope.

Neuroscience and Trauma research at Barts and The London covers a wide range of topics:general trauma and neurotrauma,neurodegeneration, neuroinflammation, pain,neuro-oncology and genomics. In trauma, thefocus is on spinal cord and peripheral nerveinjury and coagulation. The group has identifiedseveral therapeutic strategies to preventcomplications of injury, and to limit and repair itsdamage. Professor John Priestley has developedbiomaterial-based conduits for peripheral nerveand spinal cord repair and is evaluating severalnovel neuroprotective agents. Neurotex, a BLT-SMD spin-out company, has been established tocommercialise this work. Professor KarimBrohi’s group covers various aspects of traumaresearch, from injury prevention to public health,the effects of trauma on the body, the body’sresponse to injury and rehabilitation. A majorfocus of the group is trauma-associatedcoagulopathy, a research field in which thegroup is a world-leader. Traumatic brain injurywill be a major new focus of research, with theappointment of a new Professor of Neurosurgery.

Dr. Adina Michael-Titus leads the neurotraumaand neurodegeneration group. Dr. Michael-Titusand Professor John Priestley have an active jointprogramme of research on novel neuroprotectivestrategies in spinal cord injury. The group’s workon omega-3 fatty acids in neurotrauma issupported by several UK and internationaltranslational awards. Dr. Michael-Titus is alsoleading a new MRC-funded translationalprogramme on novel metal-binding compoundswith therapeutic potential in Alzheimer’s disease.

Dr. Andrea Malaspina has an active researchprogramme which covers various aspects ofamyotrophic lateral sclerosis research, fromanimal models of the disease to neuroprotectiveagents and new disease biomarkers.

Professor Gavin Giovannoni and Professor DavidBaker head up the neuroimmunology group withtheir main disease focus being multiplesclerosis. Their research is centred on immunetolerance strategies, developing neuroprotectiveand neurorestorative therapies for progressivemultiple sclerosis and manipulating cannabinoidbiology as a therapeutic strategy to improve thesymptoms of multiple sclerosis. David Baker'swork on cannabis as a potential neuroprotectantin MS continues and is currently being tested ina national MRC-funded trial under the directionof Prof. John Zajieck (Plymouth). David Baker isthe co-founder of Canbex a spin-out companythat has identified and developed a group ofcannabinoid-like compounds that are excludedfrom the CNS to treat muscle and bladderspasticity.

In neuro-oncology and genomics, ProfessorSilvia Marino's group uses molecular anddevelopmental biology approaches in mousemodels to study how cellular and molecularmechanisms controlling the development of the central nervous system can also contribute to brain tumorigenesis when deregulated.Professor Denise Sheer's group studies thefunction of human chromosomes and thegenetic basis of cancer, with a focus on criticalpathways involved in brain tumours. The neuro-oncology group are establishing a tumourbiobank with detailed clinical phenotyping.

In addition to the activity of the group leadershighlighted above, there are active researchprogrammes in motor neurone disease, pain,muscle regeneration, neuro-gastroenterology,biomarkers and clinical outcomes.

Post-graduate programmesThe Institute hosts a range of highly successfuland sought after post-graduate courses lead bysenior staff in individual academic centres, Theseprogrammes have been developed in response tothe research, teaching and training needs ofindividuals pursuing careers in disciplinesencompassed by the Institute.

The Institute takes its name from Sir WilliamBlizard, the founder of the London HospitalMedical College in 1785.

www.icms.qmul.ac.uk

Public Engagement in ScienceThe Blizard Building houses a BioscienceEducation Centre, the Centre of the Cell, whichaims to engage young people and schools in theprinciples of scientific and biomedical researchand the background to many of the majorscientific and ethical issues facing young people,educationally and socially. The Centre of the Cellopened in September 2009 and 10,000 childrenwill have visited in its first year of opening.


Blizard Institute of Cell and Molecular Science

The Blizard Institute is the largest institute ofBarts and the London School of Medicine andDentistry and aims to deliver excellence in allaspects of research, teaching and clinicalservice The BICMS comprises 400 staff andstudents based in six academic Centres eachwith focussed programmes of research whichexamine the cellular mechanisms of themaintenance of health, the response to injuryand repair and the pathogenesis of disease. The Institute was returned in Unit of Assessment4 of RAE2008 and 80% of the outputs wereconsidered world class or internationallyexcellent. This outcome placed the research ofBlizard Institute in joint first position of HospitalBased Clinical Subjects in UK medical schools.

The Institute is housed in the Blizard Building in Whitechapel. This unique research buildingprovides state of the art laboratory and officeaccommodation based on an innovative openplan design, a 400 seat lecture theatre, meetingrooms and core facilities in Flow Cytometry,Imaging, Global siRNA screening andTransgenics. The large open plan laboratoriesand juxtaposition of research Centres fromdifferent backgrounds provides the perfectenvironment for the development ofinterdisciplinary collaborative research.

www.centreofthecell.org

The Lord Brain Memorial Lecture and Medal has been established in honour and memory ofWalter Russell Brain’s outstanding contribution to the field of neurology. The memorial medal willpay tribute to healthcare professionals or scientists who have worked in the UK and have made amajor scientific contribution to the field of neuroscience. The lecture will be held biennially andhosted by the Centre for Neuroscience and Trauma in the Blizard Institute of Cell and Molecular

Science at the Barts and The London School of Medicine and Dentistry.

For further information contact:Mr Surinder PalCentre for Neuroscience and TraumaBlizard Institute of Cell and Molecular ScienceBarts and The London School of Medicine and Dentistry4 Newark StreetLondon E1 [email protected]

This booklet has been produced by the Publications and Web Office for the Barts and The London School of

Medicine and DentistryPub6616

lord brain 2010 commemorative booklet

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